Fillable Printable Form 1040 Schedule R
Fillable Printable Form 1040 Schedule R
Form 1040 Schedule R
Schedule R
(Form 1040A
or 1040)
Department of the Treasury
Internal Revenue Service (99)
Credit for the Elderly or the Disabled
▶
Complete and attach to Form 1040A or 1040.
▶
Information about Schedule R and its separate instructions is at
www.irs.gov/scheduler.
1040A
. . . . . . . . . .
1040
R
◀
OMB No. 1545-0074
2016
Attachment
Sequence No. 16
Name(s) shown on Form 1040A or 1040
Your social security number
You may be able to take this credit and reduce your tax if by the end of 2016:
• You were age 65 or older or
• You were under age 65, you retired on permanent and total disability, and
you received taxable disability income.
But you must also meet other tests. See instructions.
TIP
In most cases, the IRS can figure the credit for you. See instructions.
Part I
Check the Box for Your Filing Status and Age
If your filing status is: And by the end of 2016: Check only one box:
Single,
Head of household, or
Qualifying widow(er)
1 You were 65 or older . . . . . . . . . . . . . . . . . . . .
1
2 You were under 65 and you retired on permanent and total disability . .
2
Married filing
jointly
3 Both spouses were 65 or older . . . . . . . . . . . . . . . . .
3
4 Both spouses were under 65, but only one spouse retired on permanent and
total disability . . . . . . . . . . . . . . . . . . . . . . .
4
5 Both spouses were under 65, and both retired on permanent and total
disability . . . . . . . . . . . . . . . . . . . . . . . . .
5
6 One spouse was 65 or older, and the other spouse was under 65 and retired
on permanent and total disability . . . . . . . . . . . . . . . .
6
7 One spouse was 65 or older, and the other spouse was under 65 and not
retired on permanent and total disability . . . . . . . . . . . . .
7
Married filing
separately
8 You were 65 or older and you lived apart from your spouse for all of 2016 .
8
9 You were under 65, you retired on permanent and total disability, and you
lived apart from your spouse for all of 2016 . . . . . . . . . . . .
9
Did you check
box 1, 3, 7, or
8?
Yes
▶
Skip Part II and complete Part III on the back.
No
▶
Complete Parts II and III.
Part II Statement of Permanent and Total Disability (Complete only if you checked box 2, 4, 5, 6, or 9 above.)
If:
1 You filed a physician’s statement for this disability for 1983 or an earlier year, or you filed or got a
statement for tax years after 1983 and your physician signed line B on the statement, and
2 Due to your continued disabled condition, you were unable to engage in any substantial gainful activity
in 2016, check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
▶
• If you checked this box, you don't have to get another statement for 2016.
• If you didn't check this box, have your physician complete the statement in the instructions. You must
keep the statement for your records.
For Paperwork Reduction Act Notice, see your tax return instructions.
Cat. No. 11359K Schedule R (Form 1040A or 1040) 2016
Schedule R (Form 1040A or 1040) 2016
Page 2
Part III
Figure Your Credit
10 If you checked (in Part I): Enter:
Box 1, 2, 4, or 7 . . . . . . . . . . . . $5,000
Box 3, 5, or 6 . . . . . . . . . . . . . $7,500
Box 8 or 9 . . . . . . . . . . . . . . $3,750
}
. . . . . . . . . .
10
Did you check
box 2, 4, 5, 6,
or 9 in Part I?
Yes
▶
You must complete line 11.
No
▶
Enter the amount from line 10
on line 12 and go to line 13.
11 If you checked (in Part I):
• Box 6, add $5,000 to the taxable disability income of the
spouse who was under age 65. Enter the total.
• Box 2, 4, or 9, enter your taxable disability income.
• Box 5, add your taxable disability income to your spouse’s
taxable disability income. Enter the total.
}
. . . . . . .
11
TIP
For more details on what to include on line 11, see Figure Your Credit in the instructions.
12
If you completed line 11, enter the smaller of line 10 or line 11. All others, enter the
amount from line 10 . . . . . . . . . . . . . . . . . . . . . . . . .
12
13
Enter the following pensions, annuities, or disability income that
you (and your spouse if filing jointly) received in 2016.
a
Nontaxable part of social security benefits and nontaxable part
of railroad retirement benefits treated as social security (see
instructions). . . . . . . . . . . . . . . . . . . .
13a
b
Nontaxable veterans’ pensions and any other pension, annuity,
or disability benefit that is excluded from income under any
other provision of law (see instructions). . . . . . . . . .
13b
c
Add lines 13a and 13b. (Even though these income items aren't
taxable, they must be included here to figure your credit.) If you
didn't receive any of the types of nontaxable income listed on
line 13a or 13b, enter -0- on line 13c . . . . . . . . . .
13c
14
Enter the amount from Form 1040A, line
22, or Form 1040, line 38 . . . . .
14
15 If you checked (in Part I): Enter:
Box 1 or 2 . . . . . . $7,500
Box 3, 4, 5, 6, or 7 . . . $10,000
Box 8 or 9 . . . . . . $5,000
}
15
16
Subtract line 15 from line 14. If zero or
less, enter -0- . . . . . . . . .
16
17 Enter one-half of line 16 . . . . . . . . . . . . . . .
17
18 Add lines 13c and 17 . . . . . . . . . . . . . . . . . . . . . . . . .
18
19
Subtract line 18 from line 12. If zero or less, stop; you can't take the credit. Otherwise,
go to line 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
20 Multiply line 19 by 15% (0.15) . . . . . . . . . . . . . . . . . . . . . .
20
21 Tax liability limit. Enter the amount from the Credit Limit Worksheet in the instructions .
21
22
Credit for the elderly or the disabled. Enter the smaller of line 20 or line 21. Also enter
this amount on Form 1040A, line 32, or include on Form 1040, line 54 (check box c and
enter “Sch R” on the line next to that box) . . . . . . . . . . . . . . . . . 22
Schedule R (Form 1040A or 1040) 2016
